discretion. Despite this fact, the vast majority of companies still use urine as their specimen. With the trends noted above (decreased year over year positive rates in urine and increased year over year self-admited illicit drug use), it begs the question, are companies choosing the drug screening specimen that is right for their type of program? Broadly speaking in NREG clients fall into
two categories, the first are safety sensitive employers. Tis group of employers has workforces that are comprised of blue- collar labor who perform duties that are inherently dangerous (think of manufacturers, construction, warehousing, etc.). Tese safety-sensitive employers oſten have a drug- free workplace programs that mimic DOT programs in that they not only perform pre-employment testing, they also have testing for incumbent employees randomly and for cause (post-incidence and for reasonable suspicion). Te second category is risk adverse employers who primarily employ white-collar workers (think of financial service, insurance, retail, etc.). Te hallmark of this type drug-free workplace program is testing in the pre- employment seting only. Tese employers see the utility and appreciate the return on investment that drug-free workforce offers, but they oſten do not have the structure in place to administer incumbent employee testing. Now that the employer types have been
broadly identified, what specimen would be ideal for each type?
Federally Regulated Employers Teir core program is defined by regulation; however, risk adverse employers that are aware of the above trends have already adopted hair-testing programs layered on top of their urine programs. With FMCSA decreasing the random selection rate for motor carriers (thus decreasing some of its program’s deterrence value), all motor carriers as a best practice should consider hair testing as a barrier for employment.
60 datia focus
NREG Safety
Sensitive Employers Tese employers should seriously consider oral fluid as their specimen of choice depending on their organization’s needs. A company collector easily collects the oral fluid test on site (actually the donor collects the specimen on himself/ herself and the company representative just observes and initiates the chain of custody). Te MRO verified positive rate is almost double that of urine, and the cost of oral fluid testing is anywhere from 25% to 50% less expensive than a traditional urine test collected at a clinic.
NREG Risk Adverse Employers Tese employers desire a drug-free workplace. Many depend on their pre-employment test to deter drug-using candidates from gaining employment. Since a majority of illicit drug users are aware of the use of drug screening by an employer, when urine is their specimen of choice, these companies’ donors have a variety of ways to subvert the test. If you search “beat the drug test” on the Internet, you will literally get over one million websites back. Other than dilution (drinking more fluid than typical), the ways to beat a urine drug test are by substitution (such as using synthetic urine) or adulteration (adding a substance to one’s urine which metabolizes substances within the urine). Along with those methods, the most obvious method to beat either a urine or oral fluid test is to merely stop using illicit drugs. Drugs generally clear from urine and oral fluid rapidly (within a few days to about one week, to include marijuana) under standard drug screening conditions; therefore, a donor just needs to know about the pre-employment test for just a few days in order to stop using and may beat the test as a result. Tis is the reason why employers with this type of policy need to strongly consider hair testing. Te long window of detection and relative inability to adulterate the hair specimen makes this specimen a potentially ideal choice
for pre-employment testing for risk adverse employers. Any other specimen being used for a pre-employment test is arguably much more of an IQ test than a drug test.
Conclusion Employers should evaluate the various testing specimens to determine which specimen type best meets the needs of its organization—consider cost, whether testing can be done on-site, and the length of the detection window. When evaluating a drug screening
provider, employers may want to consider these important requirements: find a drug testing provider with deep expertise and experience in drug testing that is knowledgeable about your industry. Look for a provider that is able to offer
customized solutions, not a one-size- fits-all program. Make sure the provider offers a wide variety of drug screening specimen types and testing panels for different drugs.
Endnotes 1 2
http://www.samhsa.gov/workplace/drug-testing
https://www.congress.gov/114/bills/hr22/ BILLS-114hr22enr.pdf
Todd Simo, MD is the Chief Medical Officer at HireRight where he oversees customer-specific health and drug screening services. Prior to HireRight, he was
the Medical Director of an occupational health clinic in Virginia and owned a consulting firm providing medical director services. Dr. Simo completed his medical training at the University of Minnesota and served as a Naval Medical Officer until 1998. He is a board certified Medical Review Officer with vast experience and training in Family, Occupational and Addiction Medicine. More information can be found at
www.HireRight.com.
Spring 2016
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